Malignant Testicular Tumors in Children: A Single Institution's 12-year Experience

Study Design. We retrospectively investigated the outcomes of 42 boys aged 0-19 years presenting with testicular masses. Excluding patients with incomplete records, they were treated at a tertiary referral center between May 2006 and November 2019, which were reviewed and retrospectively analyzed based on their age at the time of admission, presenting complaints, clinical and radiological findings, tumor markers, management, and follow-up. Pathology was centrally reviewed (C.H.) in patients with a tissue biopsy, but confirmation by a central review was not required before enrollment. This retrospective study was unanimously approved by the institutional review board of Chang Gung Memorial Hospital. Their parents or legal guardians provided written informed consent through an opt-out method on our hospital website following the ethical principles for medical research involving human subjects in Taiwan.

Data Collection. The evaluation included age at presentation, medical history, clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings, and outcomes for every patient. All patients received the examinations of color Doppler ultrasonography of the testis and the abdomen, plain x-ray of the thorax, and serum α-fetoprotein (AFP) levels before operations. The AFP measurement is usually very high in newborns and does not decrease to normal adult levels until 8 months. Thus, the AFP levels of infants were evaluated according to reference ranges [4,5].

Surgical Technique All 42 tumors were treated surgically. We explored the groin through an inguinal incision. The testicle is gently grasped and exteriorized, and the spermatic cord and vessels within the tunica vaginalis are clamped. The resected tumor mass was sent for frozen section examination (FSE). Testis-sparing surgery was considered in patients with non-germ cell tumors. If the tumor had replaced the entire testis, a radical orchiectomy was taken. All tumors received histologic analysis. The optimal follow-up protocol included regular control visits with the physical examination, AFP measurements, and testicular sonography. Adjuvant chemotherapy was administered, depending on histopathology and TNM criteria for tumor classification. If non-germ cell tumors were assessed accurately on FSE, testis-sparing surgery could be considered an alternative treatment modality.